SPC365

C-reactive protein as a predictor of post-Transcatheter Aortic Valve Implantation conduction disturbances

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: André Grazina

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Posters
FP Number: ---
Authors: André Grazina; Alexandra Castelo; Ruben Ramos; António Fiarresga; Duarte Cacela; Lino Patrício ; Tiago Mendonça; Dra. Inês Rodrigues; Isabel Gonçalves Machado Cardoso; Rui Cruz Ferreira

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Introduction:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> One of the most important current limitations of </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">transcatheter aortic valve implantation (TAVI) is conduction system abnormalities and subsequent need for permanent pacemaker (PM) implantation. Inflammatory changes around TAVI device have been suggested as a possible mechanism of acute conduction system dysfunction and C-reactive protein (CRP) as a predictor of mortality after TAVI.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Objectives:</span></span></span></strong> <span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">This study aims to explore the association of the post procedure CRP levels and new onset conduction abnormalities after TAVI.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Methods:</span></span></span></strong> <span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Between 2009 and November of 2020, a total of 493 patients underwent TAVI. Blood CRP levels were determined daily until hospital discharge. Continuous Electrocardiogram (ECG) monitoring were performed in the first 24 hours in all patients and 12-lead ECG were recorded daily thereafter. 104 patients were excluded for having previous PM (n=41), evident infection or other obvious reason for CRP elevation (n=29) or having the CRP peak after 5 days of TAVI (n=34). Peak CRP levels were compared in patients with (group 1) and without (group 2) new onset conduction abnormalities or in-hospital PM implantation. A ROC Curve was used to establish an optimal cut-off for this association.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Results:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> 389 patients were included in the study, 55% female, mean age 81.7 years old. New conduction abnormalities were observed in 46.8% (182) and PM implantation in 21.1% (82). Mean peak CRP levels was significantly higher in the group 1 vs 2 (80.9 vs 100.2mg/L, p=0.002). ROC analysis established a CRP peak level of 80mg/L as the optimal cut-of-point. 48% (n=186) had CRP peak levels superior to 80mg/L (group A) and 52% (n=201) equal or inferior (group B). The baseline characteristics showed no significant difference between these groups. Peak CRP level superior to 80mg/L was significantly associated with third degree atrioventricular (AV) block (OR 2.12, p=0.005, 95%CI 1.25 &ndash; 5.00) or need for PM implantation (OR 1.82, p= 0.018, 95%CI 1.10 &ndash; 2.90), independently of the timing of the peak and baseline characteristics. No significative differences were seen in the prediction of left bundle branch block, first- or second-degree AV block by the CRP level.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Conclusions:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> In this study, post-TAVI peak CRP levels in the first 5 days after TAVI was significantly associated with development of complete AV block or need for PM implantation. Further studies are necessary to validate these findings. </span></span></span></span></span></span></p>